A comparative analysis on clinical efficacy of FOLFOX6 regimen and DCF regimen as neoadjuvant chemotherapy combined with radical gastrectomy in treating advanced gastric cancer.

PURPOSE

To compare the clinical efficacy and safety of FOLFOX6 regimen and docetaxel-cisplatin-fluorouracil (DCF) regimen as neoadjuvant chemotherapy (NACT) combined with radical gastrectomy in treating advanced gastric cancer.

METHODS

The clinical data of 96 patients with advanced gastric cancer admitted and subjected to NACT combined with radical gastrectomy in our hospital from September 2013 to September 2017 were collected, and the patients were divided into FOLFOX6 group (n=48) and DCF group (n=48) according to the NACT regimens received. The radical gastrectomy was performed about 4 weeks after NACT. After operation, the NACT regimens were continued. The efficacy of NACT, adverse reactions, operation conditions, postoperative recovery and prognosis of the patients were observed and recorded. The patients were followed up by means of outpatient visits and telephone calls, so as to understand their postoperative survival and disease development.

RESULTS

The general clinical features of the patients were comparable, and there was no death case in the perioperative period in both groups. The clinical response rates were 47.9% and 52.1% in FOLFOX6 group and DCF group, respectively, and the disease control rates were 91.7% and 89.6% in FOLFOX6 group and DCF group, respectively (p>0.05). Thirty-nine and 45 cases of adverse events occurred in FOLFOX6 group and DCF group, respectively, during NACT. Among them, there were 33 cases in grade I, 37 cases in grade II, 6 cases in grade III and 8 cases in grade IV. FOLFOX6 group had remarkably fewer cases of nausea and vomiting, leucopenia and thrombocytopenia than DCF group (p=0.004, p<0.001, p=0.030), while no statistically significant differences were discovered in other adverse reactions (p>0.05). The differences in operation time, intraoperative blood loss, number of blood transfusion, surgical approach, number of dissected lymph nodes, surgical margin and number of palliative surgery between the two groups were not statistically significant (p>0.05). Moreover, there were no statistically significant differences in gastrointestinal function recovery time, length of hospital stay and complications after operation (p>0.05). The patients were followed up for 12-60 months, and it was found that the 1-year survival rates were 91.7% (44/48) and 95.8% (46/48), respectively, and the 3-year survival rates were 62.5% (30/48) and 70.8% (34/48), respectively, in the two groups. According to log-rank test, the differences in the survival rates between the two groups of patients were not statistically significant (p=0.274).

CONCLUSIONS

The FOLFOX6 regimen and DCF regimen as NACT combined with radical gastrectomy have curative effects in treating locally advanced gastric cancer, preferable clinical response rate and disease control rate can be obtained, and the adverse reactions of the chemotherapy are tolerable. The patients receiving the FOLFOX6 regimen show a better tolerance, manifesting that the FOLFOX6 regimen is safer, which is worthy of clinical popularization.